Infection Control Today: Case Study

Jan 31, 2005

How to Secure a Peripheral IV CatheterBy Bonnie Trottier, RN, CRNI

Ask most nurses what is the best way to
secure a peripheral intravenous (IV) catheter, and youll hear only slight
variations on a theme. While techniques differ some between institutions, standard
practice involves using adhesive tape and a sterile occlusive dressing. This
general method is so widely used that any outsider would assume it works quite
well.

Discerning nurses know otherwise. Tape securement is fraught
with problems and dangers, for patients and clinicians. Tapes inadequacies
can lead to complications such as phlebitis, infiltration, migration, and
dislodgment that cause patients discomfort and harm.1 Tape is also associated
with high IV restart rates that expose healthcare workers (HCWs) to
sharps-injury risk and possible infection with life-threatening illnesses, such
as HIV or hepatitis B or C.2 In addition, these frequent IV restarts consume
time that nurses really dont have due to their patient care and paperwork
responsibilities. Unscheduled IV restarts increase use of costly materials,
especially when expensive safety catheters are used.

Although implementation isnt as widespread as it should be,
effective catheter-securement devices have been available for several years. These well-engineered devices far outperform tape in every a
dimension, providing longer dwell times, improved outcomes, and better use of
nurses time.

The Occupational Health and Safety Administration (OSHA) has
also recognized the value of securement devices. Its new document, Fact
Sheet: Securing Medical Catheters, describes the sharps injury risk that tape
securement poses to HCWs, and notes that adhesive anchors another term for catheter securement devices can
reduce or eliminate injury risk.3 The fact sheet concludes that, used in place
of tape, adhesive anchors create improved catheter stability. That in turn
decreases catheter migration, dislodgment, and the necessity of reinsertion with its associated needlestick risk.4

Our Experience with Catheter-Securement Devices

My employer, Health-First, a three-hospital healthcare system
based in Rockledge, Fla., has been using the StatLock IV Ultra catheter
securement device to secure peripheral IV catheters since late 2003. We adopted
the device after it proved itself in a rigorous clinical trial that compared
StatLock to tape and another kind of securement device. We also use a smaller version, the StatLock IV Ultra
Pediatric, for pediatric patients.

The securement device consists of a precision-molded retainer
that has been engineered to provide a tight grip around the catheter hub. The IV Ultra model snap-fits over the push-tab of the catheter
hub to secure it. The retainer is integrated onto an adhesive anchoring pad. In addition to holding catheters better than tape does, the
anchors superior securement prevents micro-movements and pistoning that
OSHA and others implicate as the cause of complications that lead to unplanned restarts.5-7

We made the decision to trial the securement device about a
year after switching from a protocol requiring IV restarts after 72 hours, to
one requiring restarts after 96 hours. Under the old protocol, only 8 percent to
15 percent of our IV placements were even lasting the full 72 hours. Once the
96-hour regimen was put in place, the situation deteriorated to the point that
nearly every catheter needed to be restarted before 96 hours.

Our administration had hoped the new 96-hour protocol would
enable us to reduce nursing payroll. Instead, personnel costs and overtime pay
rose and morale plunged. Even with our experienced IV team, nurses were
under constant pressure to keep up with the restart load. They were having a hard time fitting in routine patient care,
paperwork, and even meal breaks. After studying the research, we hoped that the securement device would reverse this problem.8-12

We trialed the device at two of our hospitals, and on our
respiratory patients, whose peripheral IVs normally have the highest failure
rate. The results astounded us.

In the securement device phase of the trial, more than 50
percent of our IVs stayed in place through the fourth day. Recall that with
taping, as few as 8 percent of our placements were making it through the third
day. The overall unplanned restart rate for the device was only 21 percent, a 70
percent improvement over the tape phase of the trial.

One recently published study reported similar results. In this
research, involving an IV team at a large VA healthcare system, the device
reduced unscheduled restarts by 63 percent, as well as total complications by 42 percent.13

The precision-engineered securement device also proved fast
and easy to apply. You can think of the application method by remembering the
four Ps: prep, press, peel, and place. As with any device, of course, you
learn some tricks when using it that are helpful supplements to the instructions
the company provides. Heres the method weve found that works the best for
StatLock IV Ultra:

Prep: After youve done your IV
stick, connected the tubing, and disposed of the stylette, use alcohol to
degrease the skin on both sides of the catheter hub. Be sure to cover the full
area where the pads will go, so theyll adhere properly. If clinically
indicated, follow-up with skin prep to enhance skin protection and adherence.
Wait 10 to 15 seconds, or until site is paper dry.

Press: Align the catheter so the
push-tab points upwards. Its very important not to squeeze the retainer
closed; press the retainer over the catheter hub so it captures the push-tab.

Peel: Pinch the devices retainer
so that it fits tightly around the catheter hub, and then peel away the paper
backing on the adhesive pads, one side at a time.

Place: Place each pad on the patients
skin after the backing is peeled. As an option, you can apply a sterile adhesive
strip over the extension set tubing to form a J-loop, as we do; indeed, a
sterile strip comes with the device for that purpose. If your institutions
policy requires it, you can then add a sterile occlusive dressing to the
insertion site, which is something we do at Health-First.

The removal process is even easier. Think of the two Ds:
dissolve and disengage.

Dissolve: The adhesive dissolves in
alcohol, so use a generous amount to loosen the edge of the pad.

Disengage: Disengage the catheter
from the devices retainer. It will lift up easily if you do this as the
directions say. Never pull up on the pad with force, because that will cause
discomfort to the patient and skin tears in patients with fragile skin.